A 1-year prospective study was carried out on patients in the ICU unit at a tertiary care hospital, Hail, Kingdom of Saudi Arabia. A total of 163 bacterial isolates were obtained from different clinical specimens with a high proportion of bacteria found associated with ventilator-associated pneumoniae (70, 43%), followed by catheter-associated urinary tract infection (39, 24%), central line-associated bloodstream infection (25, 15%), and surgical site infection (14, 8.6%). Klebsiella pneumoniae was the most common isolate (39, 24%), followed by Acinetobacter baumannii (35, 21.47%), Pseudomonas aeruginosa (25, 15%), and Proteus spp (23, 14%). Among the highly prevalent bacterial isolates, extended-spectrum beta-lactamase was predominant (42, 42.4%). Proper use of antibiotics, continuous monitoring of drug sensitivity patterns, and taking all precautionary measures to prevent beta-lactamases-producing organisms in the clinical settings are crucial and significant factors to fend off life-threatening infections and for a better outcome.

Background: Carbapenem-resistant A. baumannii (CRAB) hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) is becoming a globally therapeutic problem. Method: The open-label, randomized, superiority, single-blind trial was conducted in Rajavithi Hospital, a super-tertiary care in Bangkok, Thailand. We included CRAB HAP/VAP patients randomly assigned to receive sitafloxacin-colistin-meropenem compared to colistin-meropenem to assess mortality, clinical response, and adverse effects. Result: April 2021-2022, 77 patients were randomized and received combination treatment sitafloxacin-colistin-meropenem (n = 40) or colistin-meropenem (n = 37). Among two groups, the all-cause mortality rate was no significant difference at 7-days and 14-days (7.5% vs 2.7%; p = 0.616 and 10% vs 10%; p = 1, respectively). Patients received sitafloxacin-colistin-meropenem showed improved clinical response, compared patients receiving colistin-meropenem with both intentions to treat (87.5% vs 62.2%; p = 0.016) and per-protocol analysis (87.2% vs 67.7%; p = 0.049). The adverse effects were not different among 2 groups. Conclusion: Adding sitafloxacin as third agent in meropenem plus colistin could improve clinical in CRAB HAP/VAP with comparable adverse effects. Sitafloxacin-meropenem-colistin could be another option for combatting CRAB HAP/VAP

(1) Background: Ventilator-associated pneumonia (VAP) causes high mortality among patients with respiratory disease and imposes major burdens on healthcare infrastructure. Models that use electronic health record data to predict the onset of VAP may spur earlier treatment and improve patient outcomes. We developed and studied the performance of interpretable machine learning (ML) models that predict the onset of VAP from electronic health records (EHRs); (2) Methods: We trained Logistic Regression (LR), full feature Explainable Boosting Machine (fEBM), and eXtreme Gradient Boosting (XGBoost) ML models on data from the MIMIC- III (v1.3) database. Model performance was measured by area under the receiver operating characteristic curves (AUCs). We trained a minimal-feature EBM model (mEBM) with features derived from white blood cell (WBC) counts, duration of ventilation, and Glasgow Coma Scale (GCS). Finally, model robustness was evaluated on randomly sparsified EHR datasets; (3) Results: The fEBM model outperformed the XGBoost and LR models at 24 hours post-intubation. The mEBM model maintained an AUC of 0.893. The fEBM model performance remained robust on sparsified datasets; (4) Conclusions: Our novel interpretable ML algorithm reliably predicts the onset of VAP in intubated patients. Integration of this EBM-based model into clinical practice may enable clinicians to better anticipate and prevent VAP.

A 2-year prospective study carried out on ventilator-associated pneumonia (VAP) patients in the intensive care unit at King Khalid hospital, Hail, Kingdom of Saudi Arabia (KSA), revealed a high prevalence of extremely drug-resistant (XDR) Acinetobacter baumannii. About a 9% increase in the incidence rate of A. baumannii has occurred in the VAP patients between 2019 and 2020 (21.4% to 30.7%). In 2019 the isolates were positive for IMP-1 and VIM-2 (31.1% and 25.7%, respectively) as detected by PCR. In comparison, a higher proportion of isolates produced NDM-1 in 2020. Here, we observed a high resistant proportion of ICU isolates towards the most common antibiotics in use. Colistin sensitivity dropped to 91.4% in the year 2020 as compared to 2019 (100%). Thus, the finding of this study has a highly significant clinical implementation in the clinical management strategies for VAP patients. Furthermore, strict implementation of antibiotic stewardship policies, regular surveillance programs for antimicrobial resistance monitoring, and screening for genes encoding drug resistance phenotypes have become imperative.